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FAQs

About TMS

Transcranial Magnetic Stimulation (TMS) is a focal brain stimulation treatment that passes small electromagnetic currents through parts of the brain. Different regions of the brain can be targeted by holding a specially designed coil near the patient's scalp. Energy is then applied which stimulates nerve cells in that particular brain region.

TMS therapy doesn’t use a drug; it directly stimulates relevant areas of the brain. As a result, there are no foreign compounds introduced to the body in TMS, and it does not have the side effects typically associated with drug therapy.

TMS therapy usually involves several repetitive sessions; this is referred to as repetitive Transcranial Magnetic Stimulation (rTMS).

Positive treatment responses to TMS vary between patients. A bettering of symptoms is just one measure of success. Others include improvements in productivity, increased psychological and emotional wellbeing, improvement in sleep and in quality of life, and a reduction in the need for pharmacological treatment.

The duration of benefits can also vary between patients and conditions. For example:

In chronic pain, benefits can last up to 2 months, but usually require “top-up” sessions to maintain the improvement. How often a patient receives a top-up session can also differ. Patients can expect to receive one treatment every month to consider TMS a worthwhile treatment.

For depression and other psychiatric conditions, the response rates and remissions also vary from patient to patient. TMS treatment should be a part of broader clinical interventions and should not be seen in isolation to other forms of treatment, including counselling and practical support.

A medical practitioner who has expertise in TMS treatment will complete a thorough assessment before treatment to ensure its safety and suitability for the patient. In general, patients who have a history of epileptic seizures or those who have metal in their heads should not receive TMS. Below is a list of examples, which is not exhaustive:

  • Metal stents in the neck or brain
  • Deep brain stimulators
  • Aneurysm clips or coils
  • Metallic implants in your head, ears, eyes or neck
  • Facial tattoos with metallic ink
  • Other metal objects around your head

TMS treatment is generally safe for patients with non-epileptic seizures.

TMS is a well-tolerated treatment. It has been used to treat thousands of people, and only a small percentage discontinue treatment because of its side effects. Possible side effects may include:

Headache: this is the most common side effect and occurs in about half of patients treated with TMS. These headaches are usually minor and generally resolve throughout the treatment. Simple over the counter pain medication (e.g. paracetamol) is typically enough to address these headaches, but they are often self-resolving.

Scalp discomfort: this is usually minor and occurs in about a third of patients. This happens where the coil is placed over the scalp and often resolves during treatment. Adjustments can be made to the coil position and stimulation settings to reduce discomfort.

Seizures: This is an infrequent side effect and typically only occurs in people at an independent risk of seizures. These seizures tend to be short and self-limiting. Patients are screened before treatment to ensure they do not fall into this at-risk category. Importantly, the chance of having a seizure during a TMS treatment is lower than that while taking an antidepressant or analgesic drug.

It is important to note that all patients are monitored during each treatment session by specially trained TMS Clinicians. Any side effects will be managed and are reversible once the TMS treatment stops. As TMS is a relatively new treatment, there may be unforeseeable risks that are not currently recognized.

TMS is effective via several complex pathways. One mechanism, in particular, appears to involve opioids, which are the body’s natural pain-relieving chemicals. When TMS stimulates the brain area involved in pain, there is a significant release of opioids. In conjunction with several other brain chemical systems, this provides substantial pain relief beyond the time of stimulation.

To manage pain, an area of the brain called the primary motor cortex (M1) is typically targeted. A range of other, different regions of the brain could be stimulated for other forms of pain such as neuropathic pain, fibromyalgia, and migraines. TMS can also be used to treat tinnitus (ringing in the ears).

If you suffer from depression and have not seen significant improvement from traditional antidepressant medications such as SSRIs, SNRIs, TCAs, and MAOIs, our TMS therapy may be an excellent solution for you.

TMS Therapy has been established since 1985 as an effective alternative to some antidepressants. It has been increasingly used to treat depression, obsessive-compulsive disorders (OCD), some symptoms of psychoses (auditory hallucinations) and PTSD, among other conditions.

Research also suggests that targeting the stimulation more precisely within the area of the dorsal prefrontal cortex can improve symptoms of depression. This region of the brain is responsible for “executive functions”, such as selecting appropriate memories and inhibiting inappropriate responses.

Other psychiatric symptoms, such as OCD, require specific modification to the stimulation regions. To this end, Modalis follows well researched and published protocols.

There are various models for TMS treatment. We select the model most appropriate to the patient’s condition, the nature of their problems, concurrent therapies, and progress.

Usually, TMS requires a course of acute treatment – consecutive, daily (5 days a week) treatments – usually a total of 35 treatments. Some patients may require future, intermittent, less frequent treatments – referred to as “maintenance TMS” – which can help sustain the initial benefits for a longer period. The intensity and frequency of such maintenance treatments, if required, will be recommended to the individual patient by the treating team.

About the TMS process

You may be referred for an MRI scan prior to starting TMS treatment. This can help to rule out any organic causes for your condition.

The MRI brain images are also able to be used for Neural Navigation, to guide the placement of the coil for the patient’s individual treatment. Such navigation techniques are used to specifically determine the target site during coil placement in TMS, to help account for the patient's specific anatomical details of their individual brain structure, and place the coil with millimeter accuracy.

No; TMS is conducted in an outpatient setting. No sedation or anaesthesia is required, and the patient is fully awake and aware during the treatment. There is no specific recovery time, so patients can drive home after their treatment and resume their day.

The exact length of TMS treatment for pain varies between patients. Some patients can notice benefits after five treatments, whereas others may need to go up to 25. The length of individual treatment sessions can also vary. A typical treatment lasts around 20-25 minutes. Patients receive TMS treatment five days per week: Monday through to Friday.

We offer a considerable capacity to customise each patient’s treatment, which can be discussed with their doctor at the time of consent for treatment and during the regular reviews. We can space sessions out more if a patient is not able to come into the office every weekday.

The TMS treatment will be initiated by a specialist physician who is trained in the use of TMS. On the first session, this specialist will determine the parameters of the treatment: precise location and stimulus strength.

An experienced TMS Clinician then administers the treatment itself under the supervision of the treating specialist physician. The TMS Clinician is always present to monitor the patient throughout the treatment.

Before treatment commences, patients complete a thorough assessment with a specialist physician. This includes an MRI brain scan. This helps to ensure correct targeting of the brain.

During each treatment, patients are asked to remove any magnetic objects (e.g. jewellery, mobile phones) as these can interfere with the TMS machine. Patients may be required to wear earplugs during the treatment for their comfort as the TMS machine can produce a loud clicking sound. This sound is similar to that of an MRI machine, but usually quieter.

For each session, patients are comfortably seated in a cushioned chair, with the stimulation applied with a specific coil. There are different types of coils required for various forms of stimulation. The machine generates an electrical impulse, which results in intense but brief magnetic fields. These fields briefly stimulate the targeted area of the brain.

The first TMS session is a dosing treatment. Several measures are taken to ensure the TMS coil is correctly placed and that the right level of stimulation is applied. This involves using the TMS coil over the scalp. Several brief pulses are applied to establish the “motor threshold”. The motor threshold is the minimum amount of energy needed to elicit a twitch in the thumb muscles of the patient. It varies between individuals. Knowing the motor threshold helps to ensure the right amount of energy is used to stimulate the brain cells. The motor threshold is not checked at every treatment but may be reassessed if there is a concern this has changed.

Patients will have regular observations taken from the TMS Clinicians, and can stop a treatment at any time by asking one of the staff members present.

In order to receive TMS therapy, patients must first obtain a referral from their doctor. We accept referrals from any GP, Psychiatrist, or other allied health practitioner familiar with TMS.

Once we receive the referral, the patient will be contacted for a short screening call with one of our TMS Clinicians, and then booked in for an Initial Clinical Review with one of our TMS Specialist Psychiatrists.

During this initial consult, the TMS Specialist Psychiatrist will assess if TMS is the best clinical option for the patient, and if so, determine the appropriate protocol & dosage for the treatment.

Acute treatment: The exact length of a course of acute TMS is determined by the Specialist TMS Psychiatrist. Most patients receive 30-35 treatment sessions, however the exact number of sessions varies from patient to patient depending on the condition being treated, and other elements of the treatment. The patient’s response to TMS is regularly monitored during this acute course.

After the acute treatment, discharge report is provided to the referrer, the next stage of the patient’s treatment will be discussed. Treatment may be concluded at this point, or the patients may undergo additional maintenance sessions in future. The duration and frequency of such maintenance treatments, if required, will be recommended to the individual patient by the treating team.

For more information, please see Patient Journey.

About treatment access and costs

At Modalis we have set up multiple treatment locations for your convenience.

Our main location in Stirling is the “hub” of Modalis. Your initial review may be conducted at that location, but it could also be provided in our other clinics depending on the availability of the TMS Specialist Psychiatrists. This initial review is held to determine the most appropriate protocol for you.

After this initial review, your treatment sessions can be done at the Modalis clinic location most convenient to you. Once you have completed your treatment, a final review appointment can be done either over the phone or at the Stirling clinic.

TMS is a medical treatment that requires an assessment by a trained medical practitioner. Modalis has several specialist physicians (general psychiatrists, pain specialists, a child psychiatrist and associated neurologist) who can assist with a treatment plan. Patients need to obtain a referral to Modalis from their GP or another medical practitioner, who will then arrange an assessment session. These referrals can be directed to the individual specialist, or they will be allocated to the most appropriate specialist.

In most cases, you will not need any specific preparation before the treatment. Your doctor will have assessed you and have organised an MRI brain scan (if one is needed). You are welcome to bring a book to your treatment, as you are welcome to read, draw, or listen to a podcast during your session.

TMS therapy has recently been added to the Medicare Benefits Schedule (MBS) for eligible patients diagnosed with treatment-resistant major depressive disorder. Patients over the age of 18 years who have tried at least two classes of antidepressants but remained unwell, and have not received TMS therapy previously, are eligible for a ~80% rebate.

Individuals who do not meet the Medicare criteria can still receive treatment but will not receive a rebate by Medicare. In these cases, there is a cost of $240 for the initial session and $185 for each subsequent treatment.

TMS is fully covered under both DVA and WorkCover. The TMS funding options are more flexible with these providers. Ask our admin staff for more specific information as it depends on your specific circumstances.

See TMS Fees and Medicare for more.

Before any medical procedures, every patient is comprehensively informed about the treatment and has the opportunity to ask any questions about the process: indications, course and potential benefits as well as its side effects. Modalis strictly follows all the relevant clinical, ethical and medico-legal guidelines relating to such consent processes.

All patients are encouraged to review all the information on this website about TMS. The TMS process will also be discussed in your Initial Consult with one of our TMS Specialist Psychiatrists. Modalis encourages other people involved in your life to participate in this process.

When satisfied with the information received, a formal consent form is then signed and witnessed before the treatment takes place. This consent relates to the specific course of TMS treatment but can be withdrawn at any stage of the process.

One of our TMS Specialist Psychiatrists will assess if TMS is the best clinical option for the patient, and if so, determine the appropriate protocol & dosage for the treatment. This is based upon the patient’s specific requirements and clinical presentation.

Ready to take the next step?

Modalis Stirling

33 Cedric Street
Stirling WA 6021

Modalis Joondalup

8 Davidson Terrace
Joondalup WA 6027

Modalis Wembley

187 Cambridge Street
Wembley WA 6014

Modalis Midland

152 Morrison Road
Midland WA 6056

Modalis East Fremantle

137 George Street
East Fremantle WA 6158

Modalis Cockburn

850 North Lake Road
Cockburn Central WA 6164

Modalis Wellard

20 Ivory Way
Wellard WA 6170

Modalis Peel

16 Sutton Street
Mandurah WA 6210

Modalis Stirling

33 Cedric Street
Stirling WA 6021

Modalis Joondalup

8 Davidson Terrace
Joondalup WA 6027

Modalis Wembley

187 Cambridge Street
Wembley WA 6014

Modalis Midland

152 Morrison Road
Midland WA 6056

Modalis East Fremantle

137 George Street
East Fremantle WA 6158

Modalis Cockburn

850 North Lake Road
Cockburn Central WA 6164

Modalis Wellard

20 Ivory Way
Wellard WA 6170

Modalis Peel

16 Sutton Street
Mandurah WA 6210

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